Surgical complications after pancreas transplantation with portal-enteric drainage

Background: Despite recent advances, surgical complications remain an impor tant source of morbidity after pancreas transplantation (PTX). Several prev ious studies have delineated the surgical complications after PTX with syst emic-bladder (S-B) drainage, but data are limited regarding the incidence a nd outcomes of surgical complications after PTX with portal-enteric (P-E) d rainage. Study Design: We retrospectively studied surgical complications after 83 va scularized PTXs with P-E drainage in 79 patients (65 simultaneous kidney-PT Xs [SKPT] and 18 solitary PTXs [SPT], 8 pancreas alone and 10 pancreas afte r kidney transplantation). Twelve (15%) were retransplants. A surgical comp lication was defined as the need for repeat laparotomy within the first 3 m onths after PTX Results: A total of 53 surgical complications requiring repeat laparotomy o ccurred in 31 patients (37%). The incidence of surgical complications in SK PT and SPT was 38% and 33%, respectively. The most common indications for r epeat laparotomy were: vascular thrombosis in 13% (SKPT 14% and SPT 11%), i ntraabdominal infection in 10% (SKPT 12% and SPT 0%), intraabdominal bleedi ng in 8% (SKPT 8% and SPT 11%), and duodenal allograft leak in 4% (SKPT 3% and SPT 6%). Patient survival rates at 1 and 3 years with versus without su rgical complications were 84% and 80% versus 94% and 86%, respectively (p = NS). Pancreas graft survival rates at 1 and 3 years with versus without su rgical complications were 48% and 44% versus 89% and 76%, respectively (p < 0.0001). The incidence of surgical complications was 45% in the first 42 P -E transplantations performed between 1990 and 1995, compared with 29% in t he next 41 transplantations performed during 1996 and 1997 (p = NS). The me an number of repeat laparotomies per patient decreased from 1.2 in the form er group to 0.5 in the latter group (p = NS). The incidence rates of vascul ar thrombosis, intraabdominal infection, and duodenal leak in the former an d latter groups were 17% versus 10%, 12% versus 7%, and 2% versus 5%, respe ctively. Conclusions: Surgical complications after PTX are common, and their inciden ce and outcomes with P-E drainage are similar to those with S-B drainage. T he complication rate does not vary according to the type of transplant (SKP T versus SPT). Increasing experience with P-E drainage results in a decreas ed incidence of surgical complications. (J Am Cell Surg 1999;189:305-313. ( C) 1999 by the American College of Surgeons).